[Effectiveness of Health and Safety at Work Services (PSAL) in reducing occupational injuries in Lombardy Region]. / Efficacia dei Servizi di Prevenzione e Sicurezza negli Ambienti di Lavoro (Servizi PSAL) neella riduzione degli infortune professionali in Regione Lombardia.

INTRODUCTION: In recent years, Italy has seen a reduction in workplace accidents due to several factors, including the controls carried out by the Health and Safety at Work Services (PSAL) of the Local Health Units (ATS). OBJECTIVE: To verify the contribution of PSAL Services to injury reduction. In particular, to identify the existence of a difference between incidence rates of accidents in companies before and after inspections and possible variations in rates between inspected and non-inspected companies. METHODS: We analyzed data of the activities carried out by the PSAL Services of the Lombardy Region in the system I.M.Pre.S@ (Computerization and Health Prevention Monitoring) in the period 2010-2015, together with data from the Regional Accident Database of the National Institute for Insurance against Accidents at Work (INAIL). The "difference in difference" (DID) method was used to evaluate the different effect on inspected and non-inspected industries. RESULTS: Between the pre- and post-vigilance periods, inspected companies showed a greater reduction either of total injury rates (DID=-2.7 per 1000 worker-years; 90% confidence interval (CI): -4.1; -1.3) or of severe injury rates (DID=-1.1; 90% CI: -1.7; -0.5). These effects were visible in the majority of ATS and occupational sectors. CONCLUSIONS: This study, made possible by a valid and efficient regional data tracking system, has shown the positive effect of the PSAL prevention actions on the frequency of both total and severe injuries.

[The complaint of suspected occupational disease: news, critical issues and applicative suggestions]. / La denuncia di sospetta tecnopatia: novità e criticità normative, suggerimenti applicativi.

OBJECTIVES: The Legislative Decree n. 151 of 14 September 2015 lays down new provisions concerning the DPR 1124/65. The major developments occur with Article 53 of Presidential Decree 1124/65, which transfer the obligation to send the medical certificate, attached to the report of accident and occupational disease, from the employer to the physician - "every physician lends immediate assistance to an injured worker or to a worker that suffers from an occupational disease" - using telematic systems, either directly or through the health facilities. There are however residual critical issues not easily overcome by the general pratictioner or by the physician not specialist in occupational medicine, because of the impossibility of knowing the real occupational causative agents of disease and the production cycle. So, the general practitioner cannot properly study the link between damage to health and work. In addition, there are no indications for diseases not included by tables (DM 09.04.2008) and lists (DM 10.06.2014), which should be evaluated about the possible occupational origin. Moreover, there is no indication of reporting for the pathologies present in the tables of occupational diseases, but not included in the lists of the DM 10.06.2014, and for the diseases with nosological differences between the tables of occupational diseases and lists, as well as those that the doctor believed to be linked to exposure at work, although not included in the two documents (tables or lists). To date, there are other technical critical issues that the legislation seems to overlook. In any of the laws reported (and even in the recent legislation) is mentioned the key element essential to evaluate, according to technical and scientific criteria, the first occupational origin attribution of a suspected technopathy: the results of an appropriate and specific risk assessment of the recognized causative agent. METHODS: We propose an operational way to create a technical and sustainable system of reporting suspicious technopathies. RESULTS: This system should be based on the figure and the role of occupational physician, both as a "competent" physician, according to the Legislative Decree n. 81/08 (in Italy), both as a doctor inserted in the community and hospital health services (in Lombardy these services are organized in the Health Protection Agencies - ATS - and in the Operative Unit Hospital of Occupational Medicine (UOOML of socio-territorial health companies - ASST). CONCLUSIONS: Complementarily, an organized reporting system should be based on risk assessment (according to art. 17 of Legislative Decree n. 81/08). Other aims are to overcome outdated practices, create a constant channel of dialogue between the territorial and the hospital health centers, send and capture in a structured and efficient way reports of technopathy, track all occupational disease reports and create a dedicated archive.

[Technology upgrades and exposure to chemical agents: results of the PPTP study in the footwear industry]. / Aggiornamenti tecnologici ed esposizione ad agenti chimici: i risultati dello studio PPTP calzaturu.

In the present work the chemical compositions of the products used in shoes manufacturing are reported. The data were collected over the period 2004-2007 in 156 shoe factories in Vigevano area during a study aiming the evaluation of safety conditions and occupational exposure to hazardous chemicals of the employees. The study was part of a regional project for "Occupational cancer prevention in the footwear industry". In the first phase of the study an information form on production cycle, products used and their composition was filled during preliminary audit. In the second phase of the study an in depth qualitative/quantitative evaluation of professional exposure was conducted in 13 selected shoe factories. Data analysis showed the increase in use of water-based adhesives at expense of solvent-based adhesives, the reduction to less than 3.5 weight %, and up to 1 weight %, of n-hexane concentration in solvent mixtures, the increase in use of products containing less hazardous ketones, esters, cyclohexane and heptane. Only in very few cases, products containing from 4 to 12 weight% of toluene were used. These data attest a positive trend in workers risks prevention in shoes industry.

[Effectiveness of preventive measures for workplace health and safety in Lombardia region during the period 2007-2008]. / Applicazioni orientate all'efficacia negli interventi di prevenzione in materia di salute e sicurezza nei luoghi di lavoro realizzate in regione Lombardia nel biennio 2007-2008.

BACKGROUND: The Lombardy Region has managed workplace safety prevention projects via evaluation of efficacy indicators since 1998 but is only now measuring the effectiveness of heir application. For the 3-year period 2008-2010 Regional Law 8/2007 made it mandatory for all injury prevention departments to assess effectiveness. A study carried out by the International Labour Organization concluded that investigations carried out to identify the causes and the responsibilities of work accidents or occupational diseases are extremely effective in improving the sureveillance and prevention system. METHODS: The ratio between the number of cases in which it was possible to identify an individual who could be charged with penal responsibilities and the number of investigated cases were taken as an efficacy indicator ofHealth Service investigation procedures. RESULTS AND DISCUSSION: Analysis revealed that in only 29% of the 5008 industrial injuries, investigated and in 16% of the 2370 occupational diseases assessed was it possible to identify penal responsibilities. These percentages appear too low and a revision of the investigation protocol is therefore necessary mainly as regards priority criteria for the selection of cases to be investigated.

[Vigilance in application of law 125/2001 concerning alcohol and alcohol-related risk assessment in workplaces]. / Vigilanza sull'applicazione della legge 125/2001. Indicazioni per la gestione nei luoghi di lavoro dei rischi alcol correlati.

BACKGROUND AND OBJECTIVES: The prohibition of using, dispensing or distributing alcoholic drinks at workplaces involving an elevated risk of accidents (Art. 15 - Law 125/2001 "General policy concerning alcohol and alcohol- related problems") is consistent with the duties of employers and employees regulated by Decree 626/94. The purpose of this rule of law is the health protection of workers and of any third party in the workplace. Alcohol-addiction in workers has to be considered as part of the risk assessment and, in the case of the hazardous activities identified in the law, the increase in risk due to alcohol consumption must also be considered RESULTS AND CONCLUSIONS: Along with the prohibition of dispensing or distributing alcoholic drinks at the workplace, companies can launch training and information campaigns on the adverse health effects resulting from by harmful and hazardous alcohol consumption in workplaces, which will be all the more effective if addressed to all workers and not only to the more exposed employees. In developing this activity, the company occupational health physician has a central role to play by giving assistance to employees, involving the management and cooperating with public institutions. The controlling body will promote, support and supervise this process. In particular, the local authorities for Occupational Health and Safety (PSAL), together with social partners, will encourage companies to start up projects for health protection, will facilitate cooperation with the Pathological Addiction Services (Ser. T), and will encourage the implementation of a network to facilitate occupational health physicians in analyzing accident risks and solving health problems related to alcohol abuse.